1841748647 NPI number — BREW MEDICAL AND REJUVENATION CLINIC LLC

Table of content: WAI KAI KAREN TONG M.A, LMFT (NPI 1346561305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841748647 NPI number — BREW MEDICAL AND REJUVENATION CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREW MEDICAL AND REJUVENATION CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841748647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 HOSPITAL AVE
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
DANBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06810-5954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-244-9529
Provider Business Mailing Address Fax Number:
203-355-7147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 FEDERAL RD STE D22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06804-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-616-5963
Provider Business Practice Location Address Fax Number:
203-900-0642
Provider Enumeration Date:
09/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BREW
Authorized Official First Name:
TULIE
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
FNP
Authorized Official Telephone Number:
203-616-5963

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  006337 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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